High Quality
Open the downloaded document, and select print from the file menu (PDF reader required).
Texas
Ethics Commission
P.O.
BOX12070
Austin, Texas
78711-2070
(51
2)
463-5800
1
-800-325-8506
INTERESTSINBUSINESS ENTITIES
PART
7B
17]
NOTAPPUCABLE
Describe all beneficial interests in business entities held or acquired by you, your spouse, or a dependent child during thecalendar year.
If the
interest
was
sold, also indicate
the
category
of the
amount
of the net
gain
or
loss realized from
the
sale.
For
an
explanation
of
"beneficial interest"
and
other specific directions
for
completing this section,
see
FORM PFS--
INSTRUCTION
GUIDE.When reporting information about a dependent
child's
activity, indicate the child about whom you are reporting byproviding the number under which the
child
is
listed
on the Cover Sheet.
HELD
OR ACQUIRED BY
FILERSPOUSEDEPENDENT CHILD
DESCRIPTION
NAME AND ADDRESS
fl
(Check
If
Filer's
Home Address)
IF
SOLD
NET
GAIN
NET
LOSS
LESS THAN
35,000
Q
55,000-39,999
Q
310,000-324,999
D
S25.000-OR
MORE
HELD
OR
ACQUIRED
BY
D
FILER
D
SPOUSE
DEPENDENT
CHILD
DESCRIPTION
NAME AND ADDRESS
| |
(Check
If
Filer's
Home Address)
IF
SOLD
D
NET
GAIN
n
NET
LOSS
D
LESS
THAN
55,000
055,000-39,999 0510,000-324.999
d
S25.000-OR
MORE
HELD
OR
ACQUIRED
BY
Q
FILER
D
SPOUSE
D
DEPENDENT CHILD
DESCRIPTION
D
NAMEAND ADDRESS
(Check It
Filer's Home Address)
IF
SOLD
n
NET
GAIN
D
NET
LOSS
D
LESS THAN
35.000
QS5.000-S9.999
Q
S10,000-524,999
Q
S25.000-OR
MORE
COPYAND
ATTACH ADDITIONAL PAGES
AS
NECESSARY
Revised
02/25/200;)
Texas
Ethics
Commission
P.O.
Box
12070
Austin, Texas
78711-2070
(512)
463-5800
1 -800-325-8506
GIFTS
PARTS
\7\
NOT
APPLICABLE
Identify any person or organization that has given a gift
worth more than
$250
toyou,your spouse, or a dependent
child,
anddescribethegift.Do notinclude:
1)
expenditures requiredto bereportedby aperson requiredto beregisteredas alobbyistunder chapter 305 of the Government Code; 2)
political
contributions reported as required by law; or 3) gifts given by aperson related to the recipient within the second degree by consanguinity or affinity. For more information, see FORM PFS--iNSTRUCTION GUIDE.When reporting information about
a
dependent
child'sactivity,
indicate
the
child
about whom
you are
reporting
by
providing the number under which the child is listed on the Cover Sheet.
NAMEAND
ADDRESS
DONORRECIPIENT
D
FILER
[3
SPOUSE
DEPENDENT
CHILD
DESCRIPTION OF GIFT
NAME AND ADDRESS
DONORRECIPIENT
FILER
SPOUSE
[^DEPENDENT
CHILD
DESCRIPTION
OF
GIFT
NAME AND
ADDRESS
DONORRECIPIENT
FILER
SPOUSE
D
EPENDENT
CHILD
DESCRIPTION
OF
GIFT
COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY
Texas
Ethics Commission
P.O.
BOX12070
Austin, Texas 78711-2070
(512)463-5800
1-800-325-8506
TRUST
INCOME
J7]
NOT
APPLICABLE
PART
9
Identify
each source of income received by you, your spouse, or a dependent child as beneficiary of a trust and indicate thecategory of the amount of income received. Also identify each asset of the trust from which the beneficiary received
more
than
$500
inincome,if theidentityof theassetisknown.Formore information,seeFORM
PFS-INSTRUCTION
GUIDE.When reporting information about
a
dependent child's
activity,
indicate
the
child about whom
you are
reporting
by
providing
the
number under which
the
child
is
listed
on the
Cover Sheet.
1
SOURCE
2
BENEFICIARY
3
INCOME
4
ASSETS FROM WHICH
OVER
$500
WAS
RECEIVED
d]
UNKNOWN
SOURCEBENEFICIARYINCOMEASSETS FROM WHICH
OVER
$500
WAS
RECEIVED
D
UNKNOWN
SOURCE
BENEFICIARYINCOME
ASSETS
FROM WHICH
OVER
$500
WAS
RECEIVED
I
I
UNKNOWN
NAMEOFTRUST
D
FILER
U
SPOUSE
D
LESS
THAN 35,000
D
35,000-39,999
QnFPFNnFMTHHm
D
310,000-324,999
d
325,000-OR
MORE
NAME
OF
TRUST
rjplLER
D
SPOUSE
Q
LESS
THAN 35,000
Q
S5.000-S9.999
(TjDFPFNDFNTCHiin
Q
31
0,000-324,999
Q
S25.000-OR
MORE
NAME
OF
TRUST
n
FILER
Q
SPOUSE
DLESS
THAN
55,000
d]
55,000-39,999
n
DEPENDENT CHILD
Q
310.000-324,999
Qs25,000-OR
MORE
COPY
AND ATTACH ADDITIONAL PAGES ASNECESSARY
Add a Comment